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Home My WebLink AboutBUSINESS PLAN 7/13/1987,?0-03 SVV. I/4 OF SEC, 8 T. 30 S R. 28 E. S~HOOL DIST. 104! 2/ /'3 655.07 170-03 .400/ JO ; i I" oddy. II ii I1~ tO ~ COI~ITUid al 9(Ylroyl~ I AssESsoRs MAP NO'.!7..O..T..O..3. .... COUNTY OF KERN r;o-04 LOT26 OF sEc. 8 T. 30 .~ R28E. SCHOOL mST. /-~ ,?0-04 z~ ASSESSORS MAP N01.7.....0........0.....4. ...... COUNTY OF KERN. TE/FAC ILI TY FORM NORTH SCALE: / ~ BUSINESS NAME: DATE': ~/~//~) FACILITY NAME: (CHECK ONE) SITE DIAGR.kM FLOOR: OF ~ ' UNIT ~: OF FACILITY DIAGR.aZ' .J (.Inspector's Comments): -OFFICIAL USE ONLY- - SA - '. S~TE D[AGRA~w (Required lte~s) 1. Address: ldentt~y principle bullding~ by ~he' Street numbers. 2. -Street(s), Alleys, Drlve~ays','and ParkJng Areas adjacent to the property, include the street names. 3, Storm Drains. culverts, Yard Drains 4. Drainage Canals, Ditches. Creeks, '.Buildings .a. Frame construction b. Masonry construction c. Metal construction d. Access Door e.'6 lutY o.trols a. Gas b. Electricity c. Water Fire Suppression Systems: a. Fire Hydrants 9. Lock (key 10. MSDS Storage Box Il. Railroad Tracks 12. Fence or Barrier a. Wire b. Masonry c. Wood d. Gates 13. PoUerllnes 14'. Guard Station 15. Storage Tanks: Identify the capacity in gal. a. Above ground 16. 17. 18. b. Fire Sprinkler 19. Connections c. Fire Standpipe 20. Connections d. Water Control Valves for protectioo systems 21, e. Fire Pump 22. B. Fire Oeparteent Access b. Underground Diking or Berm Evacuatioo Route gvacuatlofl Area: Identify-the location where employees will Beet o Outside Hazardous Masts Storage Outside Hazardous .Rateria! Storage Outside Hazardous Material Use/Handling Tylm of Hazardous Material/Waste Stored or Used (See · Below) TYPS OF HSt~t~DOU$ M~TERIA~ F - Flmable g .- Zxplosive L - L/quid C ' Corrosive' 0 - Oxidizer O-'~ Gas W - Water Reactive T - Toxic 3 - Solid D - Waste 0 - gtiologica! Exaeple: Flammble Liquid - FL FACILITy DIAORA~ (Required 1tams lm addltiou to the. sbo~e) l. Risers for Sprinklers 8. 2. Partitions 3. Stairways: Indicate the ~0. levels served gram highest to lowest. 11. 4. Escalator: Indicate the leveJs served from highest to lowest. S. Elevator 13. S. Attic Access 14. 7. Skylights R - Radiologlca! P H - Cryogenic Fire Kscapes Air Conditioning Units windows Inside H~ardous Waste 3teresa Inside Hazardous Materials Storage Inside Hazardous Materials Uae/Handling Sewer Drain Inlets ORTH ;ITE/FACILITY F 0 RM .~ o,_? r OF (CHECK ONE) SITE DIAGR.~M FACILITY .DIAGRAM I(Inspector'. s Cqmm'bnts - 5A -~ nspector's Comments): -OFFICIAL USE ONLY FILE CONTENTS SUMMARY FACILITY ~ ~-- \I~3 C. ADDRESS : h)O ~. ~)on~_ ~ OOCl PERMIT #: ~-~30]~ ENV. SENSITIVITY Activity Date # Of Tanks Comments / / / GARY J. WICKS Agency Director (805) 861-3502 STEVE Mc CALLEY Director, RESOURCE U T HEALTH;SERVICES 2700 M Street, Suite 300 Bakersfield, CA 93301 Telephone (805) 861-3636 Telecopier (805) 861-3~t. 29 August 30, 1989 Victor Tack 41~0 East Planz Road Bakersfield, California CLOSURE OF i UNDERGROUND nA~AmDO~ SUBSTANCE STQRAGE TANK LOCATED AT 410 EAST PLAN2 ROAD IN THE CITY O.F BAKERSFIELD~ CALIFORNZA. PERMIT ~ A928-25/250016 This is to advise you that this Department'has reviewed the project results for ~he preliminary assessment associated w~th the closure of the tank noted above. Based upon the sample results submitted, this Department .is satisfied that the assessment is complete and no significant soil contamination has resulted f~'om discharges from the subject tank. ..Thank you for your cocDeration in this matter. T'~rRO~DA R.~CRUMPLE~, R.~.H.'S'., HAZARDOUS MATERIALS SPECIALIST cc: KERN ENVIRONMENTAL SERVICE TIME 'SE!~T: 'I F.I. ECOPI ER DELIVER THE FOLLO~)~R~ M~.~,~,C~ TO; '~UMSER ,07 E,%ATOR: (I?,~CLUD !?:G COVER PLEASE CALL t~$ .IF ?H~..~.~SSAGE %4A$ K~CE!VED !NCOMPLET£ OR )~OT L~G;3L~, THE T~L~P:qONE ):L~R !~ (~0~) 3~-9-5220. OUR ' ~" (t05) '589-7F~3.. LABORATORIES. INC. J, ,,I, .EGLIN, REG. CHEM. P-HGR, 4100 PIERCE. RD., BAKERSFIELD, CALIFORNIA 93,108 PHONE 32%4911 h:rgeable Da Report: 6444-I Ways Planz Rd ~elo~ Disr~ense= , 8/18/89 ~. $:00 pm [8-Aug-89 DATE SAMPLE 21-Aug-B9 Repo .rtlng Analysis Cormtl~uent Units Resul%s D~T~ ANALYSIS COMPLeTeD: 23-Au~-89 Minimum Benzene u~/E none ~etected Toluene ug/g none detected Eth~l Benzene u~/g none detected p-XF!ene ug/g 0.11 · --Xylene ug/g O. 21 o-~ene ~g O. 29 24.94 0 02 0 02 0 02 0 02 0 02 0 02 5'.00 ~ST ~"'T':{OD: ~ :~Or ~a~o!irAe by D.O.H. $. L, U, F. T, ~ethod. Ir~ividual oor~ti%uents 'tV. EPA method 8020. California D,O.H.$. Cert, ~102 J, J. Eglin. LABORATORIES, INC. J, J, EQUN, RE~. CHEM. ENGR. 4100 PIERCE RD,, BAKERSFIELD, CALIFORNtA 93308 PHONE 327-491t ~TX QUALITY CONTROL, DATA Kern k~nvtoz~n%al Services' ~,O.~x 5337 ~rsEield, CA 93388' At~ntion: ~lS ~c: Wa~r W~s PI~ Rd Con~=ituen% Spike ID: 64,31-4 Analysis ,T.~te: 23-Aug-89 Sample. Matrix: · Units: ~1 10' Below Dispc~nser , 8/t8/89 ~ 5:00 ~enzene Toluene Eth~! ~er. zene p-Xylene .m-Xylene o-Xylene ND \ 5.01 88,72 93,28 5,01 ND 5,03 96,10. 100.75 4.72 ND 5,09 86.96 90.24- 3,70 ND 5.02 88.67 91,85 .3.31 ND 5.11 91.28 94.32 3.28 ND 5,03 89.95 .93,~0 3,87 ND 301.06 92.60 94,77 2,32 ND = None Spiked ~le Con,:entra;:.,:,rt-- ~r~le ~n~ntra%ton % R~ove~ = ................................................ (~n,:~ntratior, O f ~pike) ~ (~el3%ive Spik~ f~]e Cone .- Spik~ 5a~!i.,ca~: ~mple ¢~nc. ............................................................................ · X (Aver~ ~nc. of Spikes) K~=n I~v:l. ornmen~.!. ServiCe~ P. O. Box 533';' LABO RATO R'I.ES, INC. 4100 PIERCE RO,, ,gAKER~FI£LD, CALiFORNiA93308 Purgeabie Aro~tics DATE SAMPLE COLLECTED: 18-Au~-89 Da'~e of Report: 25-Aug'89 ' 8/18/8~ @ 5:~0 :~ D~?~. ~E R~CEIVED ~ LAB: 21.-Aug-89 ANALYSIS 23-Au~-89 Reporl:in~ Analysis Cons~i%uent Uni~ Resultm . Benzene u~/a ~%vl ~zene ug/g p-Xylene m-Xylene ug/g o-~ylene Total PetxDle~ none detac~ none detacta~ none detected none detecte~ none detecte~ none detected 7.92 Repo~-%ir~g Level 0.02 0.02 0.02 0,02 0,02 0.02 5, O0 TEST ~:T~OD: TPH for gasoline by D,O.H.S, L.U,F,T, m~thod. Individual eon.sti~ents by ~I~A r~thcd 8020, Dry Matter' ~Basis PHONE 327.4~11 California D,O.H,$, Cer~. ~102 J. J. Eglin Analyst LABORATORIES, INC. J. J. ,~GMN. RE(k CHEM. ENC, R. 4100 PIERCE RD., BAKERSI=rELD, CALIFORNIA 93308 QUALI'~' CONTS, OL DATA PHONE 327,4911 Kern Knv~ornrre. ntel ~ervices ~'. O. Mx 63.37- ~akersfield, CA 93388 Attention: C~is DeA~r~n ".~ ~b ~: 6444-2 ~Z [5' ~lOw Dis~nser, Spike ID: ' 6431-4 .Ar~lysts D~te; Z3-aU~-89 ~i~ ~/~ 8/18/89 @ 5:20 ~n Constituent C~¢. Spike %, R~c . % ReC ~ Benzene Toluene p-X¥lene 'r,~Y~vlen~ o-Xyl~ne ~ Gas ND 5.02 88,72 ND' 5.03 96.10 ND 5.09 86.96 ND 5.02 88.67 t~D ' $. 11 01.28 ND 5.03 89,95 ND 301,06 92.60 93,28 100,75 90.24 91.65 93.5O 94,77 5.01 4,72 3.70 3.31 3.28 3,87 2.32 CC' ~r~en~,~: ND :.None Detected SPiked P. mm~'~;le Conce'~:,tration- .~ ~le C/;nCentration .......................... X 100 (~mcentratiOn of Spike) (~la%ive Pem~nt Dlff~nce) ~ ' Spik~ ~],e Cone. ,- Si:~,ked 'l)~pl~ca~ g~npl, e Conc. ......................................................................... X 100 (Aver,~e Conc. of Spikes) KERN EI li NMENT i SEE i B A Dl~on of Kern Backhoe Service, Inc. ... Contr. L/c. #432372 July 19, 1989 KERN COUNTY HEALTH DEPARTMENT Environmental ·Health Division 2700 M Street ' ' ' " "**" :~ATTENTION .,Tero~da 'Cmmplee .... .'":-:" ' - '-' '. ..... ":,":' "'''~ '~-/ "'":'." ~G~ING '.Tank Removal Projoct at' Wate~a~s Irrigation. .... , '?.~ ~.~::,.¢~, Removal Pemit No. A928-25, KES ProjeCt No. E-274.. Gentlemen: Enclosed please find copies of the laboratory analysis results and non-hazardous waste manifest from the above mentioned project. If you have any further questions or comments, please feel free to. contact the undersigned. Thank you, CHRIS B DE AlaMO,,, p~ratzons Supervmsor CBD:jm , Enclosures JUL 2 0 Ig89 ENVIRONMENTAL HEALTH REDDING DIVISION: CORPORATE ADDRESS: 3675 Charlanne, Suite A, Redding, California 96002 · (916) 223-4214' Post Office Box 5337, Bakersfield, California 93388 · (805) 589-5220 In Califor'nia · (800i 332-5376 ' C~f£AII£A~ A#AL )'SIS PETflOL£U~ LABORATORIES, Inc. J. J..EGLIN, REG. C.HEM. ENGR. 4100 PIERCE RD., BAKERSFIELD, CALIFORNIA 93308 PHONE327-4911 t%~rgeable Aromatics (SOIL) Kern Enviro~nt~l Services P.O. Box 5337 Bakersfield, CA 93388 Attention: 'Chris DeArmon Date of ,' Report: LabNo.: Sample Desc: 4322-1 . $E-274 Water Ways Irrigation T-1 Tank South 2' 6/2/89 @ 2:51 19-J,zn-89 'DATE SkMPLE COLLECTED: 02-Jun-89 DATE SAMPLE RECEIVED@.LAB: '03-Jun-89 Reporting Analysis Constituent Units '" Resuits Benzene ug/g Toluene ug/g Etb~l Benzene' ug/g p-Xylene ~g/g m-X¥1ene ug/g o-Xylene ug/g Total Petroleum F~drocarbons ~zg/g DATE ANALYSIS COMPLETED: · 16-Jun-89 Minimum Reporting Level none detec+~ed none detect~.d n~ne detected" none det~cte~d none detec~.~d none detected 0.02 O. 02 O. 02 O. 02 O. 02 O. 02 none detected 5.00 TEST METHOD: TPH for gasoline Individual constituents by EPA ~t~c~l 8020. Dry Matter th. sis ~.,~n~nts: California D.O.H.S. Cert. $102 Analyst · C#£M/CAL A/VALYS/S BORATORIES, Inc. J. J. EGLIN REG. CHEM. ENGI~. · 4100 PIERCE RD., BAKERSFIELD, CALIFORNIA 93308 PHONE 327'491 ~%~rgeable Aroma%ics (SOIL) Kern Enviro~ntal Services P.O. Box 5337 Bakersfield, CA 93388 Attention: Chris DeArmon Date of Report: 19-Jun-89 Lab No. :' Sample Desc: 4322-2 $E-274 Water Ways Irrigation T-2 Tank South. 6' 6/2/89 @ 3:03 DATE SAMPLE COLLECTED: 02-Jun-89 DATE S~!PLE RECEIVED@LAB: 03-Jun-89 DATE ANALYSIS COMPLETED: 16-Jun-89 Reporting Analysis Constituent Units ResUlts Minimum Reporting Level Benzene ug/g Toluene ug/g EtF~lBenzene ug/g p-Xylene ug/g m-Xylene ug/g o-Xylene ug/g none detected none detected none det~c+~d none detected none detected none detected 0.02 0.02 0.02 0.02 0.02 0.02 Total Petroleum Hydrocar?~ms t~/g' none detected 5.00 TEST METHOD: TPH for gasoline by D.O.H.S.L.U.F.T. ~thod. Individual constituents by EPA ~r~th~] 8020. Dr/ Matter Basis Cor~nts: California D.O.H.S. C~rt. $102 A~ [ILE BORATORIES, I r-I . J. J. EGLIN, REG. CHEM. ENGR. 4100 PIERCE RI:)., BAKERSFIELD, CALIFORNIA 93308 Purgeable Aromatics (SOIL) Kern Fmviro~ntal Services P.O. Box 5337 Bakersfield, CA 93388 Attention: Cr~is Date of Report: 19-Jun-89 'Lab No.: Sample Desc: 4322-3 $E-274 WaterWays Irrigation T-3 TankNorth 2' 6/2/89 ~ 3:09 DATE SAMPLE COLLECTED: 02-Jun-89 DATE SAMPLE RECEIVED@LAB: 03-Jun~89 DATE ANALYSIS COMPLETED: 16-Jun-89 ~ Minimum ReP°rti~ ~nalysis ~eportir~ Consti+~ent Units Results Level Benzene ug/g Toluene · ug/g EtFv1 Benzene ug/g p-Xylene ~g/g m-X¥1ene ug/g o-Xylene ug/g none detected none de+~cted none de+~=ct~d none detected none detected none detec+~gd 0.02 O. 02 0.02 0.02 0.02 0.02 Total Petroleum Hydrc~-bc.,r~s ug/g none de%ected. 5. O0 TEST METHOD: TPH for gasoline by D.O.H.S.L.U.F.T. :~thc~. Individual constituents ?~y E~A n'~thod 8020. Dry Matter B~sis Corr~nts: Califozmia D.O.H.S. Cez~. ~102 By AGIIICLIL ~'UtI~ ~H£AII~Ai APIAL ~'$15 LABORATORIES, Inc. J. J. EGLIN, REG. CHEM. ENGR. 4100 PIERCE RD., BAKERSFIELD, CALIFORNIA 93308 PHONE 327-4911 ~'geable A~m~tics (SOIL) Kern Environmer~,tal Se~,ices P.O. Box 5337 Bakersfield, CA 93388 Attention: C~is Date_ of Repc, rt: 19-Jun-89 Lab No.: S~mp!e Desc: 4322-4 '$E-274 Water Ways Irrigation T-4 Ta~d{ North 6' 6/2/89 @ 3:16 DATE SAMPLE COLLECTED: 02-Jun-89 DATE SABLE RECEIVED@LAB: 03-Jun-89 DATE ANALYSIS COMPLETED: 16,Jun-89 Re~,rti~ ;malysis C~onstituen{ Units Results Mini~zm RePOrtL~g Level ~,?enzene ug/g Toluene ug/g Ethyl Benzene ug/g p-Xylene ug/g m-Xytene ug/g o-Xylene ~g/g none detec~=d none detected none detected none detected none detected none detected 0.. 02 0.02 0.02 0.02 0.02 0.02- Total Petrole~u~ ' F~dr¢~arhDns ug/g none deC, ted 5.00 TEST' YJ~THOD: TPH for gasoline by D.O.H.S.L.U.F.T. r~'~thod. Individual ccmstituents by EPA :~th,:~ 8020. Dry,Matter Basis California D.O.H.S. Coz%"- . ~i02' g I ;malyst ' AGRICULTURE £HEMICAI ANAL Y$15 PETROL[U¥ IATORIES, Inc. '4100 PIERCE RD., J. J. EGLIN, REG. CHH. ENGR. BAKERSFIELD, CALIFORNIA 93308 PHONE 327'-4911 t~rgeable Aror~tics ' (SOIL) Kern Environmental Services R.O. Box'5337 Bakersfield, CA 93388 Attention: Chris DeArmcn Date of Report: 19-Jun-89 Sample Desc: DATE SAMPLE COLLECTED: 02-Jun-89 4322-5 ~E-274 Water Ways Irrigation P-1 Piping2' 6/2/89 @ 3:30 DATE SAMPLE RECEIVED @ LAB: 03-Jun-89 · , .'. t !*.-~0 ~it~,;: DATE ANALYSIS COMPLETED: 16-Jun-89 Constituent Reporting Units Analysis Results Minimum · Reporting Level Benzene ug/g Toluene ug/g Ethyl Benzene ug/g p-Xylene ug/g m-Xylene ug/g o-X¥1ene ug/g none detected none detracted none detec+~ none detected none detected none de+~ected O. 02 O. 02 O. 02 '0.02 · 0.02 O. 02 Total Petroleum Hydr¢~ar?~ons ug/g none detected 5.00 TEST METHOD: TPH for gasoline by D.O.H.S.L.U.F.T. rrmthod. Individual cor~sti~ents by EPA rr~th~] 8020. Dr~ Matter B~sis Comrr~nts: California D.O.H.S. · Cez%.. ~102 ANAL YSlS P[TROL£LI~t LABORATORIES, Ir]c:. J. J. EGLIN, REG. CHEM.'ENGR. 4100 PIERCE RD., BAKERSFIELD, CALIFORNIA 93308 PHONE 327-4911 Kern Environmental Services P.O. Box 5337 Bakersfield, CA 93388 At~ntion: Chris DeArmon 'Lab No.: Sample besc: ~'geable Aromatics (SOIL) 4322-6 $E~274 Water Ways Irrigation P-1 Piping 6' 6/2/89 @ 3:36 Date of Report 19-J~n-89 DATE SAMPLE COLLECTED :' 02-Jun-89 DATE Sk~LPLE RECEIVED @ LAB: 03~Jun-89 DATE ANALYSIS COMPLETED: 16-Jun-89 Minim. am · Reporting Analysis Reporting Constituent Units Results Level' Benzene ug/g Toluene 'ug/g Ethyl Benzene ug/g p-Xylene ug/g m-Xylene ug/g o-Xylene t~/g Total Petrole~zm Hydrocar~,ns none detected none detectr=d none det~c_t~3d none detected none detected none detected ug/g none det~ta~] 0.02 O. 02 0.02 0.02 0.02 0.02 5.00 TEST METHOD: TPH for gasoline by D.O.H.S.L.U.F.T. rrethod Individual constituents bM EPA ~r~thod 8020. Dry Matter B~sis C~o~r~rents: California D.O[H.S. ~ert. $102 AG#ICLIL TUI~ C~I£A~ICAZ A#A~ YSlS .... LABORATORIES, Inc., J. J. EGLIN, REG. CHEM. ENGR. '4100 PIERCE RD., BAKERSFIELD, CALIFORNIA 93308 PHONE 327-4911 Purgeable A~ra~tics (SOIL) Kern Environmental 'Services P.O. Box 5337 Bakersfield, CA 93388 Attention: Chris DeArmon 19-Jun-89 Lab No..::' ~4322-7 Sample Desc.: ~E-274 Water Ways Irrigation .D-1 Dispenser 2' 6?02/89 @ 3:59 DATE SAMPLE COLLECTED: 02-Jun-89 DATE SAMPLE RECEIVED @ LAB: 03-Jun-89 DATE ANALYSIS COMPLETED: 16-Jun-89 Constituent. Reporting Units Analysis Results Minim~ Reporting Level Benzene ug/g Toluene ug/g .Ethyl Benzene ug/g p-Xylene ug/'g m-Xylene ug/g o-Xylene ug/g None Detected 12.00 None Detected None Detected None Detected None Detected Total Pet. Hyclrocar?J:~.ns ug/g 190.00 O. 02 O. 02 0.02 0.02 O. 02 O. 02 5.00 TEST METHOD: TPH for gasoline by D.O.H.S.L.u.F.T. ~r~thod. Ir, dividual cor.,stituents by. ~A ~thod 8020. Dz~ Mater ~sis .' O~,ff~nts: California D.O.H.'~. Cez%. ~102 Analyst Cit£MICAZ ANA~ YSlS PET#OL£U~ RATORIES, Inc. J. J. EGLIN, REG. CHEM. ENGR. 4100 PIERCE RD., BAKERSFIELD, CALIFORNIA 93308 PHONE 327-4911 Purgeable Aromatics (SOIL) Kern Environmental. Services P.O. Box 5337 Pakersfield, CA 93388 Attention: Chris DeArmon Da~ of Report: Lab No.; Sample Desc: 4322-8 ~E-274 Water Ways Irrigation D-2 Dispenser 6' 6/02/89 @ 4:09 19-J~m-89 DATE SAMPLE COLLE~ED: 02-Jun-89 DATE. SAMPLE RECEIVED @ LAB: 02-Jun-89 ~ Reportir~z Analysis Constituent Units Results Benzene ug/g none detected Toluene ug/g none detected Ethyl Benzene ug/g none detec~.?~ed p-Xylene ' ~g/g' 0.14 m-Xylene ug/g 0.21 o-Xy!ene ug/g 0.45 'Total Petro!e~m Hydrocar'~,ns ug/g '72.86 DATE tNALYSIS COMPLETED: 15-Jun-09 Minimum Repcrting Level O..02 O. 02 O. 02 O. 02 O. 02 O. 02 5.00 TEST M~fHOD: TPH for gasolir~e by D.O.H.S.L.U.F.T. rr~thod. Individual cor~stituents by EPA rr~thod 8020. Dz7 Matter Basis C~r:mentg:. Califorr~ia D.O.H.S. Cez%. ~102 A Division of Kern Backhoe Service. Inc. I(ERN ENVIR ONMENT.,4 L SERVICE P. O. BOX 5337 - BAKERSFIELD, CA 93388 (805) 589-5220 CHAIN OF CUSTODY RECORD P~O'Ji~,O. 'j~'nO.Jl[cT ! . ~ " Rllinqu~thed by: tl,~tv~l Dali I T,me ' Received by: I I' ~~'~ ~i,~,'''''''~''' ~% ~/~1 Well, Tank No. Field 6r Area KF. RN BflCKH[IE' 5ERUICF. INC. KF.RN UACUUM ~ERUICF. ' '; i':.. , P.O. BOX §337 · BAKERSFIELD, CALIFORNIA 93388 " " ~"'~ ' (805) 589-5220 N.° 10105 City, State, Zip .'~...~_..~.~/,~_/-~ _~. Phone ~-'_- Order PlaCed 'By ~,~---~-[-k.~' '-~'-'.~_~_ · ""' Sij~mh:~e of~A, uthorized-Afleot .. Date Title Ticket # '~-~1 Z~--"~ Unit No. /'%'[:::> [] Gloves ' [] Goggles Quantity' ..~//~'~r"~ ~ESIGNATED FACILI~ Address ~ ~ )~~ City, State, Zip' ~~~~ / /5/ Name I~---z~-~(' ~-~.~~.,l.~Oc~'"- ~~,.,'",,~"- Address ~'~r-~ City, State, Zip Phone Sig~A~~_ Driver Date (Facility Operator Must Complete) Name Address City, State, Zip Phone I Disp. TiCket # · Signature of Authorized Agent Date Pick Up Date ~-~,-~-~? Time'/ AM - NOTE.. This form to be used in lieu of the California.Department of Health Ser- vices Hazardous Waste Manifest for NON-HAZARDOUS wastes only. REMARKS: Qu. antity Received Bbls. Date Time [] PM DISPOSAL METHOD: [] Surface Impoundment [] Injection [] Landfill [] Other /?.z!:/,, Copy p).. GENERATOR UNLESS OTHERWISE SPECIFIED NOTE: It is not necessary to send copy to Dept. of Health Services. NO HAZARDOUS FEES SHOULD BE LEVIED ~ NON-HAZARDOUS WASTE HAULER RECORD TO BE USED FOR NON-HAZARDOUS WASTES ONLY . (Generator Must Complete)'.. "" WAsTE,To BE.DISPOSED Name ~.~/./:~t~~ J J/k,V,,~ I~ [Z." j~ Type/-.)~./_~.z~'m~--~,,,~O Field Address ,Z//o '.~.__~.T.~ -j~/_.,~~ Generating Location - Special Handling Instructions: ~O~th er 1700 Flower sueel B~ker.~fleld, Cnlllornla g3305 T.elephone (805) 861-3636' KERN ~OUN'rY IIEAIZH-I DEI)ARTMENT ENVIRONMENIAL HEAL3H DIVISION HEALTH OFFICER Leon M Hebertson, M.D. DIRECTOR OF ENVIRONMENTAL HEALTH Vernon S. Relchard Kern County Permit # '-- ~ ~J~T' .:.' . - ~ :'.L~~G ' - -' ' ' ' -" ' '::'~..':.: ('~' '~This ~ocm la to be ceturned [0 the gem county Health De artment '"'-.~ ':. ' ' '.;,_aya o~ acceptance or tank(s) by ,disposal o~ recycling facility.--The ' "}~'::~.'J,:' r::'"~'~': ~'h~l'2e~ 'or ~he pe'cm'l~ 'with numbec,.n°ted above la ceaponalble loc lnsuclng ~;~' ,. ~::i.~;'[''-~.'C,;;.:- ~hat~t~is focm la completed and retUrned '~ , ~ ~ ~ ~? ~,,~': ': .... . - ' ....... ~." ' · ..... · ' · '.~ ,' ';" ';'.~'~;F";, ..'.~'- ~; ,-; .... '%- '"~ ?'~:~'~":,Bm',. . see~lea ~ ~;~ ~ ~llzed ou~ ~ ~nk re~oval contractor= ":?:':'~":: ..... ~" :, ',::;':~ Tank ~e=oval contcacto~= ~ ~O~Lf~~~O Oa[e Tanks Removed ~-~.~ No. of Tanks / · .... ...... ....._ ...... . ................. : .......... - Section 2 - To be r~lled ouC ~ cou~vac~o~ "decontaminating ~ Tank "Uecon~am~nakton" Con,fac[or ~ ~~~~ ~~ Address ~ ~ .~~ Phone e ~~B~~ ,C~ _ Zip ~~ Authorized rep.resen~a~lve of con~rac~o~ ceP~tfles by sl~n~n~ below ~ha~ ta~kfs~ have been deconCa~iJm~ed ~n accordaace. ~i~h [er~ County Dep~t~ requirements. ~ ~ . , ...... , . Title Section ~' To be ~l~l;d" · ..... -- ~ ou~ aad sl~ ~y. an authorized ~eP~eseaCa~lve o~ treatment, ~, oz~ ~lsposal ~acllt~ pcceptlng ~: Data'Tanks lle~ve(i~ No, of Tanks ~ (Auth zed Represen [a'tlve ) ~ ;.j"~ ~- ..... "* * * ~ILINO' INSTRUCTIONS: Fold In half and staple. DISTRICT OFFICES Form. Approved Old8 No · '.. Toxic Subatanc.e Control Oivl: '. "- ' :'~. SaCramenlo. Cailler Into~m,lioe In the .boded lrela "%. required bY Federal. law. '...?;:. ' rlllSpOflli,'l lO '?' ,:Quantify .. EPA'8700--~ ~:~ .';' .?Inv..g-.88) prlvtoul'ldltionl.lrl ( ~',: llld Ir. clIII fled Packed m,J - th,t theI Content- ~ ' ' ' ' :~' ' ' · ,,. ,. .......... : e..n..l, regul,tlon., . .... ....... d,ere In III reepects n prO-er c ....... er.e tully lnd ,ccurately deacr bed ,h,~;; .*. · .,- q,anllly generato~...... ' '...: .... ;. -: ... ?,,.....~..,.:~ :.·. ,..f .....~,,...;l ;:. :.~ 7.~, :~:: ~ · ,. ~ , , ,,~.,way according Io ~+ ~to be eco~omlcaav ~,,,,,~._k. , I.ce~tlfy th, I I h,ve a',,r~--' ,: "": "' * "'.':~' -'...':~ :...~1 9 :,~, ::. ~ .:'., ,, .... .... . . . . pp cable Intem,tion, i and' "'Present and t.....=L'-~-"~'u"me .n(I Ih, t I have ue .... ~,,~,~,am m pmce fo reduce ~he',;~.;--" '** '~"" ' ";':' · -' ' ~ . ' ' " ' ' '..': . ' :·· ~', -,--- intent to -,,,,sa [ne pract eib --.~,..e eno toxic ti f ' ,..l ~lO.,.r,,io, ..~ ,.I.ct th.' hLh,;:~.?_I'~_ ,,d the .,v,,om.n:. O, l,?.=:?°.L°!. 'r.'l~.., :tar. O.. or {:.°oow:.~t:z~_'.?'ed !.o · :-l-~ ..0 .-anagsment method tha~ - ' .... - o.-,, quantity generator I h--;~--~-'''''"""y ava,ama lo me which - lvauame at I c,n affor~ --~ ..jauu. a gooq f,lth etfort to ~ ::,}.' ~. .ii ,..','la : . ~.l ,...,.. I , .:~., .l..1%:l:'". 'd~,~ .: :,.;. ,~:l::,t :: .. al.,. . ..,. . . ,.S....~:ll~::..:a:;:?:.. ~:~.:: l. :l~,, . .:'l ~., ~.~ '. ,j.. ::~l:: ~'l;: :"(~'0;...~': ,::' l.~ ~l;l,.l lt. ~.... . '. l,. ' ~ ·. ':''?i.',. .... Ot ..' ~ f' '. '/;t~'Ll:'''~k:':'~:~'''''"!~]~l~} L"'I'':L:?i:: ' ' ' ' ' .~ :l.., ' ' . l~ .... '~::'I''~''L:I'::'''" ''2' :;.., .:..l. l: ~:'...l.: ' ~ :.,,.~ .l..,~ ::::?'/' :l':ll:l.l :'' 'l' ::.l'. b.':".. :-... ' ','" 'r','.. : :,.: , ~ .,.,'....; ,... . · ~,;/;'.,' -...-.:.... .,.: ..%':.'.~;: ,' ..~ :.~ : .; 4;.~.~.~. '~ ?':..° t, '..' '. ...· . ...... . ' .- .' .... ,.. ..'.: .'~}, ,, ~,.',... :,~.::'- ,: ':. =:, .:-..... "~;,.'~ :..~:,. ? .... .. ~.. :~. .':-;-<.' ..... . .... : ":,..~:'-, :? ,? .?.:..,. ?).,~' ,'../... ' , ,..';'. '-~ . .~-'. :'~.~ ? 5::' ,~,:.':~;:. :'; ..: '.' .. .~ · '," '. ," '~'..: '....:'~,i'.:' - ' ' ' ' ! "": GIBSON Oil & REFINING CO., INC. 3300 TRUXTUN AVENUE, SUITE 200 · BAKERSFIELD, CA. 93301 · ~8,05] ,3.27~04i~-' DESTINATION: CARRIER ARRIVED TO UNLOAD LOADED FROM GIBSON OIL REFINERY COMMERCIAL DRIVE BAKERSFIELD, CA. 93308 CARRIER AM PM LOADER'S SIGNATURE REMARKS COMMODITY QUANTITY START TO UNLOAD WEIGHT TAG NUMBER DATE, MANIFEST # INVOICE TO: PRICE: TEMP. GRAV. NET GALLONS iBBLS FINISH UNLOADING . AM PM UNLOADED TO %._) .:........~ ~. DRIVER'S SIGNATURE ,. AM WASHOUT NET ' RECEIPT TICKET ~82~6 2700 ~ st, u*, s,,,a Bakersfield. CA 93301" (8~S) 861-3636 '~', · ?: ,,:,.,j:.~-.:, ~ (88S) 861-.%4~9 Fax PERMIT FOR PE~ENT CLOSURE OF UNDERGROUND HAZARDOus. COU T Environmental-Health Services Department PERMIT NUMBER A928-25 -,' SUBSTANCES. STORAGE FACILITY ~ · -=' "'- ::''~:~ ~ :. ~: Wat~a~ I~fion ~ee~ .. .~ctor Ta~ ' ' ' ...... ~ ~~ S~ce P.O. Box 5337 Bakersfield, CA i-.icen~e # 432372 Phone # $8%5220 410 E. Planz Road Bakersfield, CA 410 E. Planz Road Bakersfield, CA Phone # 805-831-3535 PERMIT FOR .CLOSURE OF ! TANK(S) AT ABOVE LOCATION PERMIT EXPIRES APPROVAL DATE APPROVED BY August 11, 1989 Brian PitI~ ................. ~ ...................................................... POST ON PREMISES~ ................ ; ............................................. CONDITIONS AS FOLLOW: 1. Permirtee must notify_ the County Environmental Health Department at (805) 861-3636 two Working da~ prior to tank (removal) to arrange for required inspeCtion(s). 2. Permittee must obtain a City Fire Department permit prior to initiating closure action. 3, Tank closure activities must be per Kern County Environment21 Health and' Fire Department approved methods as described in Handbook UT-30, ..... ~ERMIT FOR PERMANENT CLOSURE OF UNDERGROUND HAZ~tDous SUBSTANCES STORAGE FACILITY ." 4. Soil Sampling PERMIT NUMBER A928-25 " ADDENDUM .'.,~: :: : "/ ~ Any, deviation from sample locations and numbers or constituents to be Sampled for which are described below and in Handbook #UT-30 must receive prior approval by the Environmental Health Department. a. (Tank size 1,000 gallons or less)-a minimum of two samples must be-retrieved beneath the center "Of the tm& at depths of approximately two feet and six feet. · 5. Tank removal contractor must have a quM~fied company, employee'on-site Supervising the acmal tank -removaL .. .~ .... :..... ., 6..: ...~:: .If a~l, y, eontracto,ll~ oth,er than,tl~,.ose, listed on .permit and permit applieatiOn are'to ,b.e fiHH~ed, prior approval : .:. .... "Z?%~':,':.a , · · · ' ' : -' -', :'-:,.'"-:-: :'.~-,.~rL'--~:~%;,:' ~,-~'~,.~{:,:-,~,~:,'Ja-.~'=';~.{'~'¢;"~)~'~..t,: '<;:~:..,?,- ' ...... : mum or two samples must be remeved at depths of approxzmately two feet and sm feet for every 15 ',; :~:~"::::.':: ::::::::::::::::::::: '.:::O:~:..- tleaded/Urdeaded) gasoline.,samples must be dnalYZed f0: benzene,:'toliiene ene·""?iit iotal 9. Copies of transportation manifests must be submitted to the 'Health 'Department within five days; Of waste disposal . 10. . All applicable state laws for hazardous_waste d~Posal, transportation, or treatment m~st be adhered to. The · · Kern County Environmental Health Department must be notified before moving and/or disposing of any contaminated soil ' .... ' "~,.:' ' .-.. 11. Permittee is respousible for making sure that "tank disposition tracking record" issued with this permit is properly filled out and returned within 1,I days of tank removal 12. Advise this office of the 'time and date of the proposed sampling with 24 hours advance notice. 13. Results must be submitted to. this office .within three days of analysis Completion.. ACCEPTED~ ,~-~? ~ BP:dr pit'rs\waterway, per 5/11/18 DIVIgION O? ENVIRONNENTAL UEALTN ~?oo PLO~ER 8TREBT~ BARBRSPIBLDt CA!i (aDa) APPLI CATIOlt ' DATE # OP TANKS TO LENGTH OF PIPING TO ABANDON z THIS APPLICATION IS POR ~RE;HOVAf., OR AJPpraI CATT ON FOR PERMIT FOR PERiVL/LI~TENT I: L O S Ui~ E/AB~L.N'D ONME N T OF UNDERGROUND l{ a"LZ ,~k.l~.D O U S S U B S T.a~&.&.~,4 C E S S TORAG lrP. FACILITy O AEAJ~DO~M£NT IN PLACE (PILL OUT p.,NE APPi. ICATION PER FAC!LITY} PROJECT CONTACT CHRIS B. DE ARI~f0N eACILITY aAaE Waterways Irrigation Engineers Inc. 0NHliR Victor Tack. rASE REMOVAL CONTRACTOR J PJIONE 8 J DAYS- [,ObReslEpjqltrS. 589-5220' 1410 g. Planz Road [ Same Kern Environmental Service leEC/T/R (RO~i, LOCATIONS ONLY} Sec. 8; T30S, R28E ' f~ssr CB0SS BTRZET nigh Avenue .oaE(805 :) 831-- 3535 i~DReSB · ' 93388 i PHONE P. O. Box 5337, Bakersfield, Ca. (805)589 .:--5220 .. ] IHSURER JClifford Bradford PROPOSED .PROJECT STARTJNO DATS Itel.PORtIA LICENSE ~ [NORKgR'S CO~PJSNSATZOH Upon Permit Apprpval I 432372 I WC 581-71-04 PRELIMINARy BZTB ABEEESJ4ENT CONTP~CTOR' ADDRESS Same Same ~'01LK~R'8 C014PENSATZON 8 INSURER LaBOJ~ORY TILAT ~LL ~NAL~rZe S~L~ B C T*,abs ~ORE~ ~100 Pierce Rd, Bakersfield or National'Toxicology Labs 3101 16th Street, Bakersfield, Ca. PJIONi~ ( i ) Sa~e .PJtO. N~ .P"oae ~805 ,327-4911 '805 ~22-4~50 ~'ATEa TO .PACILI?y .PEO¥IO£D 'BY On Site ·Water Well DATES STORED 'CIIBMICAL .P~ZW0UBL~ STONeO 1971 To 1988 None TO TO. TO. NEAREST HATER NELl, - OJV~ DISTANCE A~D DESP.~ APpro×imatel¥ 150 feet .S/W of E3AOI$ ~'OR SOIL TYPE A.HD UROUND~ATER DEPTH Soil Conservation Service / tOTAL NUNBER OF EA~PLEB TO as ANALYZED PIPINO Same "TO OROUNDNATER ,T ,pACILITY .ina Fine Sandy L~am 8PORTATION ransportea DllIP. O,BA/~ COHPA~JA.8) ~ _ Wi:~ a ma~lzesg to ' /ed. and.t~ansported,Ko either~ /an metaA.xecyczxng tuntarzo, ua.) TITLE 'Operations Supe~isor ' 'PROVIDE DRAWING 05' 'I~~' LAYOUT OF FACILITY USING f'~' ALT. OF THE FOIJ_K~ING INFORMATION MUS____~T BE INCLUDED IN ORDER FOR APPLICATION TO BE PROCESSED: .. TANK{S), PIPING & DISPENSER(S), INCLUDING LMNGTHS AN~J DIMENSIONS PROPOSED 'sAMPLING LDCATIONS DESIGNATED BY THiS SYMBOL "(~" NEAREST STREET OR INTERSECTION ~ ~-ANY WATER: W~r,r.q OR SURFACE WATERS WITHIN 100' RADIUS OF FACILITY NORTH ARROW ' .- ~ CHARGES PAST DUE 'ARE SUBJECT ID PENALTy' 410 E pI. AXZ ROAD : L ' ' ptEASE RETURN fills ~TI~'TO iNSURE CORRECT pAYMENT iDENTIFICATION · . DETACH HERE ~ · ' .... ', :" ',. , . ' - ' · SAN JO~QUIN ,,.,*, 21850 ¥I. MANN. lNG AVE. SAN JOAQUIN*, CA 93660 (209) 693-2441 . MolHII (209) 445-4246 IRRIGATION ENGINEERS, INc. BAKERSFIELD (Main) OFFICE P. O. Box 4188 410 E,~$T pLANz ROAQ BAKERSFIELD. CALIFORNIA 93387 TELEPHONE (805) 831-3535 Kern :CoUnty Health %700 ?lower Street Bakersfield, Calif.. ~. : ". .'.::.:-~: ' .-.:~. 7mr i. 1 93305 RE: Invoice ~ 2%0016C-89 GREENFIELD HWY. 101 $O, MONTEREY COUNTY GREENFIELD, CA 93927 · (408) &74-5550 198-9 .: · . . ::,.,, .. ,..'.: , i': .'i? "'. .... ,.~:?..~: "-: :'!'?.:,? :::'~:-:.::~;!.?,::...i.. · -::-..... ..-~. ..... , .- -' '"":~ .... : ' '.'::::'::. '.:?':-This..':-letter --i-s.:to i:n [orm: -you, that~ we-- d'o- no~ o~erate the .underground stor~,te facility., 'Ioca.tedl.at-410 E. Planz Road, Bakersfield, Ca.. The storage facil.ity has not been used for at 'least six months. If you have an~ questions concerning this matter please contact Jon Tk~c, at 831-3535. Sincerely, , Vicki Kitchen, bkper COr)V /nailed to : K.C. Environmental Health 2700 "M" Street Ste 300 Bks. Ca.~ 93301 KERN COUNTY HEAL~.DEPARTMENT · 1'700 FLOWER STREET..· ' '": B/~,'.ERSFIELD, CALIFORNIA 93305 ~'."('805~ 861-3636 · "" .: ' ,,;:(/" . .. WATeR-'WAYS' INC. 'WATER-.-WAYS, INC. 410 E. PI, ANZ ROAD BAKERSFiELD, CA 93307 03, 1.7/8'3 I I. CNARGES PAST DUE ARE SUBJECT TO PENALLY " 'L_. DETACH HERE-'~' · (_ i' '.'- '." ' . .' ..[SEND:PAyM'ENT WiTHIN'-?,O DAYS TO AVOID ANNUAl-, FEE FOR PER~i'[ TO OPI;] R-~'IC I:- UNDER(]ROUND pLEASE '~E~'U~ TH~S'P°Rno~ TO ~SUR~ CORRECT p~,Y~ENT 5O% PENALTY ..~ AMOUNT~., STORAGE FACILITY 100. O WITIt t TANK(S') ~,OCATED AT: 410 E. PLANZ ROAD BAKERSF!EI, D- ' KE.. COU.TY .~^LT..E,.~.T,~Em' :::,=,~.~,~X~k~i:~~:'h'' . - . . i 700 FLOWER .STREET ,.~ ~1. o-,~ ,,..H SAN JOAQUIN ' 21850 Wo MANNING AVE. SAN JOAQUIN, CA 93660' (209) 693o244! Mobile (209) 445-4.246 IRRIGATION ENGINEERS, INC. BAKERSFIELD (Main) OFFICE P. O. Box 4188 4[0 EAST PLANZ ROAD BAKERSFIELD, CALIFORNIA 93387 TEiLEPHON£ (805) 831-3535 · GREENFIELD HWY. 101 SO. MONTEREY couNTy GREENFIELD, CA' 93927 (408) 6.74-5550 April 4, 1989 Kern County Health Department· 1700 Flower Street Bakersfield, Calif 93305 RE: Invoice ~ 250016C-89 This letter is to inform you, that we do not operate the underground storage facility, located at 410 E. Planz Road, Bakersfield, Ca.. The storage facility has not been used for at least six months. If'you have any questions concerning this matter, please contact Jon Tkac, at 831-3535. Sincerely, Vicki' Kitchen, bkper ENVIRONMENTAL HEALTH Kern county Health Der' ~tme~ /f--- Envlronmen_dl tie~l~th ~ ~ivision of ' 1700 Flower Street, Bakersfield, CA 98305 (80§) 86~-3636 " APPLICATION FOR PERMIT TO OPERATE UNDERGROUND HAZARDOUS SUBSTANCES STORAGE FACILITY Type Of Application (check): ~]New Facility~]Modification Of Facility~xisttng Facility OTransfer Of Ownershtp A. Emergency 24-Hour Contact (name, area 6ode, phone): Days ,-~{-- No. Of Tanks I · Type Of Business (check): OGasoline Station ~ther .(describe) {~l~ Is Tank(s) Located On An Agricultural Farm7 ~]Yes Is Tank(s) Used Primarily For Agricultural Purposes7 ~es Nearest CroSs St. (Rural Locations Only) } Faclllty.,Address ~10. T ~ R SEC Address Operator Adduess Water To Facility Provided By. ~-~_ Soil Characteristics At Facility Basis For Soil Type and Groundwater Depth Determinations Contact Person Zip ~O7 Telephone Contact Person Zip Telephone ~ .' ., Depth to Groundwater Co Contractor Address PFoposed Starting Date Worker's Compensation Certification No. If This permit Is For. Modification Modifications Proposed.,', CA Contractor's License No. Zip Telephone Proposed Completion Date Insurer Of An Existing Facility, Tank(s) Store (check all that apply): Tank # Waste Product Motor Vehicle Unleaded Regular Premium Fuel [] [] [] lB" [] [] [] [] [] O [] [] [] [] [] [] [] [] [] [] Briefly Describe F. ; Diesel Waste Oil [] [] [] '. [3' Chemical Composition Of Materials Stored (not necessary for motor vehicle fuels) Tank · Chemical Stored (non-commercial name) CAS # (if known) Chemical Previously Stored (if different) G. Transfer Of Ownership Date Of Transfer PreviOus Owner Previous Facility Name I, accept fully all obligations of Permit No. issUed to I understand that the Permitting Authority may review and modify or terminate the transfer of the Permit. to Operate this underground storage facility upon receiving this completed form. This-form has been completed under ~enalty of perjury and to the best of ,my knowledge is true and correct. 'Signature ~" ~~ Title ~-~&~' Facility Name -H. TANK # IFILL OUT SEPARATE FORM R EALH TANK) FOR EACII SECTION, CIIECK ALL APPROPRIATE BOXES 1. Tank is: [] Vaulted [] Non-Vaulted [] Double-Wall '[] Single-Wall 2. Tank Material ~" Carbon Steel [] Stainless Steel [] Polyvinyl Chloride [] Fiberglass-Clad Steel [] Fiberglass-Reinforced Plastic [] Concrete . [] A~uminum' [] Bronze []Unknown [] Other (describe): 3. Primary Containment Date Installed Thickness (Inches) Capacity (Gallons) ~ Manufacturer 4. Tank, Secondary, Containment [] Double-Wall [] Synthetic Liner [] Lined Vault [] None [q~Unknown ~, Other (describe): Manufacturer: Material Thickness (Inches) -Capacity (Gals.) 5.'Tank Interior Lining [] Rubber [] Alkyd []Epoxy []Phenolic [-] Glass [] Clay, [] Unlined [~nknoWn [] Other (describe): 6~ Tank Corrosion Protection [] Galvanized ii. Fiberglass-Clad [] PolYethylene Wrap [] Vinyl Wrapping` []~,-Tar or Asphalt [~ Unknown [] None [-] Other (describe): " Cathodic Protection: ~N0ne [] Impressed Current System ~ Sacrificial. Anode System [] Describe System & Equipment: 7. Leak Detection, Monitoring, and Interception a. Tank: .[] Visual (vaulted tanks only.) [] Groundwater Moditoring Well(s) [] Vadose Zone Monitoring Well(s) [] U-Tube Without Liner [] U-Tube with Compatible Liner Directing Flow To Monitoring Well(s)* [] Vapor Detector *[-] Liquid Level Sensor* [] Conductivity Sensor* [] Pressure Sensor In Annular Space Of Double Wall Tank * [] Liquid Retrieval & Inspection From U-Tube, Monitoring Well Or Annular Sp~ce [] Daily Gauging & Inventory Reconciliation [] Periodic Tightness Testing [] None ~ Unknown [~ Other b. Piping: [] Flow-Restricting Leak Detector(s) For PressUrized Piping* [] Monitoring Sump With Raceway [] Sealed Concrete Raceway [] Half-Cut Compatible Pipe Raceway [] Synthetic Liner Raceway [] None [-]Unknown [] Other *DescPibe Make & Model:'. 8. Tan~ Tightness Has ThiS Tank Been Tightness Tested7 Date Of Last Tightness Test Test Name 9. Tank Repair Tank Repaired? [] Yes [] No Date(s) Of Repair(s) Describe Repairs [] Yes [~No [] Unknown Results Of Test Testing Company []Unknown 10. Overfill Protection [~Operator FillS, Controls, & Visually Monitors Level [] TaPe FloatGauge [] Float Vent Valves [] Auto Shut-Off Controls [] Capacitance Sensor .~"Sealed Fill Box [] None [] Unknown [] Other: List Make & Model For Above Devices 11. Piping a. Underground Piping: ~'Yes [] No [2] Unknown Material Thickness (inches) ~ Diameter ~ Manufacturer [~ Pressure ~]"Suction [2] Gravity Approximate Length Of Pipe Run. b. Underground Piping Corrosion Protection: . [] Galvanized [] Fiberglass-Clad [] Impressed Current [] Sacrificial Anode Polyethylene Wrap [] Electrical Isolation [] Vinyl Wrap []Tar or Asphalt Unknown [] None [] Other (describe): : c. Underground Piping Secondary Containment: ' [] Double-Wall [] Synthetic Liner System [] Nohe [] Unknown .j--J Other (describe):